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Amjad I, Niazi IK, Kumari N, Duehr J, Shehzad G, Rashid U, Duehr J, Trager RJ, Holt K, Haavik H. The effects of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with attention deficit hyperactivity disorder: a pilot RCT. Front Psychol 2024; 15:1323397. [PMID: 38770250 PMCID: PMC11104450 DOI: 10.3389/fpsyg.2024.1323397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/11/2024] [Indexed: 05/22/2024] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a neurobiological disorder characterized by inattention, hyperactivity, and impulsivity. We hypothesized that chiropractic adjustments could improve these symptoms by enhancing prefrontal cortex function. This pilot study aimed to explore the feasibility and efficacy of 4 weeks of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with ADHD. Methods 67 children with ADHD were randomly allocated to receive either chiropractic adjustments plus usual care (Chiro+UC) or sham chiropractic plus usual care (Sham+UC). The Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS), Swanson, Nolan and Pelham Teacher and Parents Rating Scale (SNAP-IV), and ADHD Rating Scale-IV were used to assess outcomes at baseline, 4 weeks, and 8 weeks. Feasibility measures such as recruitment, retention, blinding, safety, and adherence were recorded. Linear mixed regression models were used for data analysis. Results 56 participants (mean age ± SD: 10.70 ± 3.93 years) were included in the analysis. Both the Chiro+UC and Sham+UC groups showed significant improvements in total and subscale ADHD scores at 4 weeks and 8 weeks. However, there were no significant differences between the two groups. Conclusion This pilot study demonstrated that it was feasible to examine the effects of chiropractic adjustment when added to usual care on ADHD outcomes in children. While both groups showed improvements, the lack of significant between-group differences requires caution in interpretation due to the small sample size. Further research with larger samples and longer follow-up periods is needed to conclusively evaluate the effects of chiropractic adjustments on ADHD in children.
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Affiliation(s)
- Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Physical Therapy Department, Riphah International University, Islamabad, Pakistan
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland, New Zealand
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Jens Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Gulyana Shehzad
- National Intitute of Psychology, Quid e Azam University, Islamabad, Pakistan
| | - Usman Rashid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Jenna Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Robert J. Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
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Ging-Jehli NR, Arnold LE, Van Zandt T. Cognitive-attentional mechanisms of cooperation-with implications for attention-deficit hyperactivity disorder and cognitive neuroscience. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:1545-1567. [PMID: 37783876 DOI: 10.3758/s13415-023-01129-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Abstract
People's cooperativeness depends on many factors, such as their motives, cognition, experiences, and the situation they are in. To date, it is unclear how these factors interact and shape the decision to cooperate. We present a computational account of cooperation that not only provides insights for the design of effective incentive structures but also redefines neglected social-cognitive characteristics associated with attention-deficit hyperactivity disorder (ADHD). Leveraging game theory, we demonstrate that the source and magnitude of conflict between different motives affected the speed and frequency of cooperation. Integrating eye-tracking to measure motivation-based information processing during decision-making shows that participants' visual fixations on the gains of cooperation rather than its costs and risks predicted their cooperativeness on a trial-by-trial basis. Using Bayesian hierarchical modeling, we find that a situation's prosociality and participants' past experience each bias the decision-making process distinctively. ADHD characteristics explain individual differences in responsiveness across contexts, highlighting the clinical importance of experimentally studying reactivity in social interactions. We demonstrate how the use of eye-tracking and computational modeling can be used to experimentally investigate social-cognitive characteristics in clinical populations. We also discuss possible underlying neural mechanisms to be investigated in future studies.
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Affiliation(s)
- Nadja R Ging-Jehli
- Department of Psychology, The Ohio State University, Columbus, OH, USA.
- Department of Cognitive, Linguistic, & Psychological Sciences, Carney Institute for Brain Science, Brown University, Providence, RI, USA.
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University, Nisonger Center UCEDD, Columbus, OH, USA
| | - Trish Van Zandt
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Scholze DA, Gosdin MM, Perez SL, Schweitzer JB. Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis. JMIR Form Res 2023; 7:e47409. [PMID: 37695648 PMCID: PMC10520768 DOI: 10.2196/47409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their child's needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. OBJECTIVE Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. METHODS This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. RESULTS Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. CONCLUSIONS ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format.
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Affiliation(s)
- Danielle A Scholze
- MIND Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, United States
| | - Susan L Perez
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, United States
| | - Julie B Schweitzer
- MIND Institute, University of California, Davis, Sacramento, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
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Kamimura-Nishimura K, Bush H, Amaya de Lopez P, Crosby L, Jacquez F, Modi AC, Froehlich TE. Understanding Barriers and Facilitators of Attention-Deficit/Hyperactivity Disorder Treatment Initiation and Adherence in Black and Latinx Children. Acad Pediatr 2023; 23:1175-1186. [PMID: 36997150 PMCID: PMC10524141 DOI: 10.1016/j.acap.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Despite evidence that consistent treatment is important for Attention-Deficit/Hyperactivity Disorder (ADHD) management, ADHD treatment initiation and adherence remains suboptimal in minoritized children. The goal of this study was to explore barriers and facilitators to ADHD treatment initiation/adherence for minoritized children to further inform development of our family navigation intervention. METHODS Using a virtual platform, we completed 7 focus group sessions (total n.ß=.ß26) and 6 individual interviews with representatives from 4 stakeholder groups: experienced caregivers of children with ADHD, caregivers of children newly diagnosed with ADHD, family navigators, and clinicians who care for children with ADHD. All caregivers identified as Black and/or Latinx. Separate sessions were conducted for each stakeholder group and caregivers had the option to attend an English or Spanish session. Using a thematic analysis strategy, barriers and facilitators to ADHD treatment initiation and/or adherence were coded in focus group/interview data and themes were identified across groups. RESULTS The primary barriers to ADHD treatment initiation and/or adherence identified for minoritized children were lack of support from school/healthcare/family members, cultural barriers, limited resources, limited access, and treatmentconcerns, with variability in endorsement across participants. Reported facilitators included caretakers having experience with ADHD, strong support, access to resources, andwitnessing their child...s functional improvement with treatment. CONCLUSIONS Caregiver experience with and knowledge about ADHD, support, and access to resources facilitate ADHD treatment in minoritized children. The results from this study have the potential to improve ADHD treatment initiation/adherence and outcomes for minoritized children through the development of culturally tailored, multipronged interventions.
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Affiliation(s)
- Kelly Kamimura-Nishimura
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Hannah Bush
- Department of Pediatrics (H Bush), Cincinnati Children...s Hospital Medical Center, Ohio.
| | - Paola Amaya de Lopez
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Lori Crosby
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Farrah Jacquez
- Department of Psychology (F Jacquez), University of Cincinnati, Ohio.
| | - Avani C Modi
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Tanya E Froehlich
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
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Ryst E, Childress A. An updated safety review of the current drugs for managing ADHD in children. Expert Opin Drug Saf 2023; 22:1025-1040. [PMID: 37843488 DOI: 10.1080/14740338.2023.2271392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers. AREAS COVERED This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described. EXPERT OPINION Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.
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Affiliation(s)
- Erika Ryst
- College of Education and Human Development, University of Nevada, Reno, USA
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA
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Southon C. The relationship between executive function, neurodevelopmental disorder traits, and academic achievement in university students. Front Psychol 2022; 13:958013. [PMID: 36118426 PMCID: PMC9478894 DOI: 10.3389/fpsyg.2022.958013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022] Open
Abstract
Difficulties with executive function have often been identified in individuals with various neurodevelopmental disorders such as Autism Spectrum Disorder (ASD), Attention-Deficit Hyperactivity Disorder (ADHD), and Developmental Co-ordination Disorder (DCD). Additionally, in childhood and adolescence, executive functioning is an important predictor of academic achievement. However, less research has explored these relationships in adult students, and those with a high level of neurodevelopmental disorder traits but no clinical diagnosis. Therefore, the current study aimed to assess whether ASD, ADHD, and DCD traits can predict academic achievement in university students, and whether traits of these neurodevelopmental conditions moderate the relationship between executive function and academic achievement. Both neurotypical students and those with a clinical diagnosis of a neurodevelopmental disorder were able to participate, with the majority being neurotypical. Participants completed four self-report questionnaires and provided a measure of academic achievement based on their university assignment results. Traits of ASD, ADHD, and DCD alone did not predict achievement, however, traits of ADHD and DCD significantly moderated the relationship between executive function and academic achievement. ASD traits did not significantly moderate this relationship. Implications and suggestions for future research are also discussed.
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Kamimura-Nishimura KI, Brinkman WB, Epstein JN, Zhang Y, Altaye M, Simon J, Modi AC, Froehlich TE. Predictors of Stimulant Medication Continuity in Children with Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2022; 43:311-319. [PMID: 35316245 PMCID: PMC9329173 DOI: 10.1097/dbp.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the simultaneous impact of patient-related and parent-related factors, medication-related factors, and health care system-related factors on attention-deficit/hyperactivity disorder (ADHD) medication continuity. METHOD Stimulant-naïve children (N = 144, M age = 8 yrs, 71% male) with ADHD completed a methylphenidate (MPH) trial and were followed for 1 year after trial completion and return to community care. Multivariable analysis investigated predictors of (1) having at least 1 filled ADHD prescription after return to community care versus none and (2) having more days covered with medicine after return to community care. Predictors included race; age; sex; income; baseline ADHD symptom severity; MPH trial experience; child and parent mental health conditions; and parent beliefs about ADHD, ADHD medications, and therapeutic alliance. RESULTS One hundred twenty-one children (84%) had at least 1 filled ADHD medication prescription (mean = 178 d covered by medication) in the year after return to community care. Multivariable models found that a weaker perceived clinician-family working alliance predicted not filling any ADHD prescriptions. Among those who filled ≥1 prescription, factors linked to fewer days of ADHD medication coverage included child sociodemographic factors (non-White race, older age, being female, and lower income), lower parent beliefs that the child's ADHD affects their lives, and higher parent beliefs that medication is harmful, while child oppositional defiant disorder and parental ADHD predicted having more days of medication coverage. CONCLUSION Child demographic factors, parent beliefs, and medication-related factors are associated with continuation of ADHD medication. These findings may facilitate the development of effective strategies to improve ADHD medication continuity for children from diverse groups.
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Affiliation(s)
- Kelly I. Kamimura-Nishimura
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - William B. Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Community and General Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jeffery N. Epstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Yin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - John Simon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Avani C. Modi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Tanya E. Froehlich
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Law E, Sideridis G, Alkhadim G, Snyder J, Sheridan M. Classifying Young Children with Attention-Deficit/Hyperactivity Disorder Based on Child, Parent, and Family Characteristics: A Cross-Validation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159195. [PMID: 35954547 PMCID: PMC9368489 DOI: 10.3390/ijerph19159195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
We aimed to identify subgroups of young children with differential risks for ADHD, and cross-validate these subgroups with an independent sample of children. All children in Study 1 (N = 120) underwent psychological assessments and were diagnosed with ADHD before age 7. Latent class analysis (LCA) classified children into risk subgroups. Study 2 (N = 168) included an independent sample of children under age 7. A predictive model from Study 1 was applied to Study 2. The latent class analyses in Study 1 indicated preference of a 3-class solution (BIC = 3807.70, p < 0.001). Maternal education, income-to-needs ratio, and family history of psychopathology, defined class membership more strongly than child factors. An almost identical LCA structure from Study 1 was replicated in Study 2 (BIC = 5108.01, p < 0.001). Indices of sensitivity (0.913, 95% C.I. 0.814−0.964) and specificity (0.788, 95% C.I. 0.692−0.861) were high across studies. It is concluded that the classifications represent valid combinations of child, parent, and family characteristics that are predictive of ADHD in young children.
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Affiliation(s)
- Evelyn Law
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
- Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
- Singapore Institute of Clinical Sciences, Agency of Science, Technology and Research, Singapore 117609, Singapore
| | - Georgios Sideridis
- ICCTR, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Primary Education, National and Kapodistrian University of Athens, 157 72 Athens, Greece
- Correspondence:
| | - Ghadah Alkhadim
- Department of Psychology, College of Arts, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia;
| | - Jenna Snyder
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA; (J.S.); (M.S.)
| | - Margaret Sheridan
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA; (J.S.); (M.S.)
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EEG Global Coherence in Scholar ADHD Children during Visual Object Processing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105953. [PMID: 35627489 PMCID: PMC9141182 DOI: 10.3390/ijerph19105953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
Among neurodevelopmental disorders, attention deficit hyperactivity disorder (ADHD) is the main cause of school failure in children. Notably, visuospatial dysfunction has also been emphasized as a leading cause of low cognitive performance in children with ADHD. Consequently, the present study aimed to identify ADHD-related changes in electroencephalography (EEG) characteristics, associated with visual object processing in school-aged children. We performed Multichannel EEG recordings in 16-year-old children undergoing Navon’s visual object processing paradigm. We mapped global coherence during the processing of local and global visual stimuli that were consistent, inconsistent, or neutral. We found that Children with ADHD showed significant differences in global weighted coherence during the processing of local and global inconsistent visual stimuli and longer response times in comparison to the control group. Delta and theta EEG bands highlighted important features for classification in both groups. Thus, we advocate EEG coherence and low-frequency EEG spectral power as prospective markers of visual processing deficit in ADHD. Our results have implications for the development of diagnostic interventions in ADHD and provide a deeper understanding of the factors leading to low performance in school-aged children.
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Effects of the Targeted Intervention for Five- to Six-Year-Old Children Affected by Attentional and Concentration Developmental Risks: Results of a Dynamic Prospective Cohort Study Conducted in Socially Deprived Regions in Germany. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:996-1006. [PMID: 35353247 PMCID: PMC9343306 DOI: 10.1007/s11121-022-01362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/12/2022]
Abstract
Epidemiological data reveal that there is a need for prevention measures specifically targeted at children with low SES. In the German federal state Mecklenburg-Western Pomerania preschools in socially deprived regions can apply for additional funds to support children with developmental risks. Mandatory criteria for obtaining these funds involve an annual assessment of all children using the “Dortmunder Developmental Screening for Preschools (DESK 3–6 R).” This instrument can detect and monitor developmental risks in the domains fine motor skills, gross motor skills, language, cognition, and social development. In this study, we examine the domain “Attention and concentration,” which is included for the 5 to 6-year-old age group, using data from two consecutive survey waves (sw). Research questions: (1) Does the prevalence rate ratio (PRR) improve over time? (2) Is the rate of improvements (developmental risk at sw1, no developmental risk at sw2) higher than the rate of deteriorations (no developmental risk at sw1, developmental risk at sw2)? Prospective cohort analysis (n = 940). The prevalence rate of a developmental risk in this DESK domain decreases over time (PRR = 0.78; p = 0.019). The ratio of the rate of improvements is 8.47 times higher than the rate of deteriorations. The results provide evidence of the effectiveness of targeted intervention measures in preschools focusing on skills that improve attention and concentration. This is significant considering the small-time interval and the categorization method of DESK scores. Nevertheless, over the same time period, the DESK results of some children deteriorated. Therefore, preschools also have to be aware that it is natural for some children to show modest declines in their skills over time. German Clinical Trials Register, ID: DRKS00015134, Registered on 29 October 2018, retrospectively registered.
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Carrasco KD, Chuang CC, Tripp G. Shared Predictors of Academic Achievement in Children with ADHD: A Multi-Sample Study. J Atten Disord 2022; 26:573-586. [PMID: 33998322 DOI: 10.1177/10870547211012039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify common and shared predictors of academic achievement across samples of children with ADHD. METHOD Two clinically referred samples from New Zealand (1 n = 88, 82% boys; 2 n = 121, 79% boys) and two community samples from the United States (3 n = 111, 65% boys; 4 n = 114, 69% boys), completed similar diagnostic, cognitive and academic assessments. Hierarchical multiple regression analyses identified significant predictors of word reading, spelling, and math computation performance in each sample. RESULTS Entered after IQ, semantic language, age at testing, and verbal working memory emerged as consistent predictors of achievement across academic subjects and samples. Visual-spatial working memory contributed to variance in math performance only. Symptom severity explained limited variance. CONCLUSIONS We recommend evaluations of children with ADHD incorporate assessments of working memory and language skills. Classroom/academic interventions should accommodate reduced working memory and address any identified language weaknesses.
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Affiliation(s)
- Kelly D Carrasco
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan.,Victoria University of Wellington, New Zealand
| | - Chi-Ching Chuang
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan.,University of Ryukyus, Okinawa, Japan
| | - Gail Tripp
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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Anderman EM, Gilman R, Liu X, Ha SY. The relations of inattention and hyperactivity to academic cheating in adolescents with executive functioning problems. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric M. Anderman
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
| | | | - Xingfeiyue Liu
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
| | - Seung Yon Ha
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
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Harstad EB, Katusic S, Sideridis G, Weaver AL, Voigt RG, Barbaresi WJ. Children With ADHD Are at Risk for a Broad Array of Adverse Adult Outcomes That Cross Functional Domains: Results From a Population-Based Birth Cohort Study. J Atten Disord 2022; 26:3-14. [PMID: 33090057 DOI: 10.1177/1087054720964578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify patterns ("classes") of outcomes for adults with and without childhood ADHD. METHOD Subjects were 232 childhood ADHD cases and 335 non-ADHD referents from a 1976 to 1982 birth cohort. We used latent class analyses to identify classes based on a broad array of adult psychosocial outcomes and determined the proportion of subjects with childhood ADHD within each class. RESULTS A three class solution provided optimal model fit; classes were termed "good," "intermediate," and "poor" functioning. Subjects with childhood ADHD comprised 62.8% of the "poor," 53.5% of the "intermediate," and 24.9% of the "good" functioning class. The "poor" functioning class was distinguished by increased likelihood of legal trouble and substance use disorders and included more individuals with childhood ADHD and psychiatric disorder than the "intermediate" class (45.5% vs. 30.6%). CONCLUSION Children with ADHD are at risk for adverse adult outcomes in multiple domains and co-morbid childhood psychiatric disorders increase risk.
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14
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Kannen K, Aslan B, Boetzel C, Herrmann CS, Lux S, Rosen H, Selaskowski B, Wiebe A, Philipsen A, Braun N. P300 Modulation via Transcranial Alternating Current Stimulation in Adult Attention-Deficit/Hyperactivity Disorder: A Crossover Study. Front Psychiatry 2022; 13:928145. [PMID: 35923453 PMCID: PMC9339709 DOI: 10.3389/fpsyt.2022.928145] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A repeated finding regarding event-related potentials (ERPs) is that patients with ADHD show a reduced P300 amplitude. This raises the question of whether the attention of ADHD patients can be increased by stabilizing the P300. Assuming that the P300 is generated by event-related oscillations (EROs) in the low frequency range (0-8 Hz), one approach to increase the P300 could be to stimulate the patient's P300 underlying ERO by means of transcranial alternating current stimulation (tACS). The aim of this follow-up study was to investigate this hypothesized mechanism of action in adult ADHD patients. MATERIALS AND METHODS Undergoing a crossover design, 20 adult ADHD patients (10 female) received an actual stimulation via tACS on one day and a sham stimulation on another day. Before and after each intervention, EEG characteristics (P300 amplitudes, low frequency power) and attention performances (d2 attention test, visual oddball task (VOT)) were recorded. RESULTS Electrophysiological analyses revealed no evidence for an enhanced P300 amplitude or low frequency power increase after actual stimulation compared to sham stimulation. Instead, a significant effect was found for a stronger N700 amplitude increase after actual stimulation compared to sham stimulation. Consistent with the P300 null results, none of the examined neuropsychological performance measures indicated a tACS-induced improvement in attentional ability. CONCLUSION Contrary to a previous study using tACS to modulate the P300 in adult ADHD patients, the current study yields no evidence that tACS can increase the P300 amplitude in adult ADHD patients and that such P300 enhancement can directly improve neuropsychological parameters of attention.
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Affiliation(s)
- Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Cindy Boetzel
- Experimental Psychology Lab, Department of Psychology, Carl von Ossietzky University, Oldenburg, Germany
| | - Christoph S Herrmann
- Experimental Psychology Lab, Department of Psychology, Carl von Ossietzky University, Oldenburg, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Rosen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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15
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Cocomello L, Dimagli A, Biglino G, Cornish R, Caputo M, Lawlor DA. Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis. BMC Cardiovasc Disord 2021; 21:549. [PMID: 34798837 PMCID: PMC8603574 DOI: 10.1186/s12872-021-02349-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults. METHOD Studies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD. RESULT Out of 1537 articles screened, we identified 11 (N = 104,585 participants, 10,487 with CHD), 10 (N = 167,470 participants, 11,820 with CHD), and 8 (N = 150,813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR = 1.38, 95% CI [1.16, 1.65]), complete secondary education (OR = 1.33, 95% CI [1.09, 1.61]) or vocational training (OR = 1.11, 95% CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity. CONCLUSION This systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.
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Affiliation(s)
- Lucia Cocomello
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | | | - Giovanni Biglino
- Bristol Medical School, Tyndall Avenue, Bristol, BS8 1UD, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rosie Cornish
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, Terrell St, Bristol, BS2 8 ED, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
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16
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Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2021; 41 Suppl 2S:S35-S57. [PMID: 31996577 DOI: 10.1097/dbp.0000000000000770] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder and is associated with an array of coexisting conditions that complicate diagnostic assessment and treatment. ADHD and its coexisting conditions may impact function across multiple settings (home, school, peers, community), placing the affected child or adolescent at risk for adverse health and psychosocial outcomes in adulthood. Current practice guidelines focus on the treatment of ADHD in the primary care setting. The Society for Developmental and Behavioral Pediatrics has developed this practice guideline to facilitate integrated, interprofessional assessment and treatment of children and adolescents with "complex ADHD" defined by age (<4 years or presentation at age >12 years), presence of coexisting conditions, moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.
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17
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Effect of a parent agreement on return rates of Vanderbilt assessments and treatment adherence in pediatric attention-deficit/hyperactivity disorder patients. EXPERIMENTAL RESULTS 2021. [DOI: 10.1017/exp.2021.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Objective
We implemented a parent–teacher Vanderbilt agreement program to increase return rates of Vanderbilt assessment scales for children in our primary care practice, and compared the assessment return rate before and after agreement signature.
Methods
We retrospectively reviewed children diagnosed with attention-deficit/hyperactivity disorder (ADHD) who had a signed Vanderbilt agreement and were under continuous care at our clinic. Return rates were compared 1 year before and 1 year after the agreement date.
Results
Among 195 children, prior to the agreement, 71% returned teacher assessments, and 59% returned parent forms; after the intervention, assessment rates were not significantly different (76%, p = .255; and 65%, p = .185, respectively). The median number of returned assessments increased after the agreement.
Conclusions
Lack of documented parent and teacher Vanderbilt assessments remain a barrier to appropriate management of ADHD. Improving the rate of assessments returned is an important outcome for treating ADHD in the primary care setting.
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18
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Glasofer A, Dingley C. Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review. J Racial Ethn Health Disparities 2021; 9:2027-2048. [PMID: 34520001 DOI: 10.1007/s40615-021-01142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.
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Affiliation(s)
- Amy Glasofer
- School of Nursing, University of Nevada, Las Vegas, NV, USA.
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19
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Evaluating Therapeutic Effects of ADHD Medication Objectively by Movement Quantification with a Video-Based Skeleton Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179363. [PMID: 34501952 PMCID: PMC8431492 DOI: 10.3390/ijerph18179363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/14/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in children. Several scales are available to evaluate ADHD therapeutic effects, including the Swanson, Nolan, and Pelham (SNAP) questionnaire, the Vanderbilt ADHD Diagnostic Rating Scale, and the visual analog scale. However, these scales are subjective. In the present study, we proposed an objective and automatic approach for evaluating the therapeutic effects of medication in patients with (ADHD). The approach involved using movement quantification of patients’ skeletons detected automatically with OpenPose in outpatient videos. Eleven skeleton parameter series were calculated from the detected skeleton sequence, and the corresponding 33 features were extracted using autocorrelation and variance analysis. This study enrolled 25 patients with ADHD. The outpatient videos were recorded before and after medication treatment. Statistical analysis indicated that four features corresponding to the first autocorrelation coefficients of the original series of four skeleton parameters and 11 features each corresponding to the first autocorrelation coefficients of the differenced series and the averaged variances of the original series of 11 skeleton parameters significantly decreased after the use of methylphenidate, an ADHD medication. The results revealed that the proposed approach can support physicians as an objective and automatic tool for evaluating the therapeutic effects of medication on patients with ADHD.
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20
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Coxe S, Sibley MH, Becker SP. Presenting problem profiles for adolescents with ADHD: differences by sex, age, race, and family adversity. Child Adolesc Ment Health 2021; 26:228-237. [PMID: 33350581 DOI: 10.1111/camh.12441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience developmentally distinct challenges from children and adults with ADHD. Yet no work in this age group identifies treatment-related phenotypes that can inform treatment matching, development of tailored treatments, and screening efforts. METHOD This study uses Latent Profile Analysis to detect unique presenting problem profiles among adolescents with ADHD and to test whether these profiles differ by key individual characteristics (age, sex, race, family adversity level). Participants were 854 ethnically diverse adolescents (ages 10-17) from the ADHD Teen Integrative Data Analysis Longitudinal (TIDAL) dataset who were assessed at clinical referral. Parent, adolescent, and teacher ratings, educational testing, and school records measured eight key presenting problems at intake. RESULTS A three-profile solution emerged. ADHD simplex (63.7%) was characterized by a mix of the ADHD-Inattentive and ADHD-Combined subtypes, moderate impairment levels, and infrequent comorbidities. ADHD + internalizing (11.4%) was characterized by higher likelihood of comorbid anxiety and/or depression. The disruptive/disorganized ADHD (24.9%) profile was characterized by severe organization, time management, and planning (OTP) problems, the ADHD-Combined subtype, and frequent disruptive behavior at school. Age did not vary across these phenotypes. More females were present in the ADHD + internalizing phenotype; males were more likely to be found in the disruptive/disorganized ADHD phenotype. Higher family adversity and African American race were associated with the disruptive/disorganized ADHD phenotype. CONCLUSIONS Adolescents with ADHD demonstrate varying presenting problem phenotypes that vary by sex, family adversity, and race/ethnicity. Consideration of these phenotypes may inform treatment matching and efforts to improve screening among under-diagnosed groups.
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Affiliation(s)
- Stefany Coxe
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Margaret H Sibley
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Son HM, Lee DG, Joung YS, Lee JW, Seok EJ, Chung TM, Oh S. A novel approach to diagnose ADHD using virtual reality. INTERNATIONAL JOURNAL OF WEB INFORMATION SYSTEMS 2021. [DOI: 10.1108/ijwis-03-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The current golden standard for attention deficit hyperactivity disorder (ADHD) diagnosis is clinical diagnosis based on psychiatric interviews and psychological examinations. This is suboptimal, as clinicians are unable to view potential patients in multiple natural settings – a necessary condition for objective diagnosis. The purpose of this paper is to improve the objective diagnosis of ADHD by analyzing a quantified representation of the actions of potential patients in multiple natural environments.
Design/methodology/approach
The authors use both virtual reality (VR) and artificial intelligence (AI) to create an objective ADHD diagnostic test. Diagnostic and statistical manual of mental disorders, 5th Edition (DSM-5) and ADHD Rating Scale are used to create a rule-based system of quantifiable VR-observable actions. As a potential patient completes tasks within multiple VR scenes, certain actions trigger an increase in the severity measure of the corresponding ADHD symptom. The resulting severity measures are input to an AI model, which classifies the potential patient as having ADHD in the form inattention, hyperactivity-impulsivity, combined or neither.
Findings
The result of this study shows that VR-observed actions can be extracted as quantified data, and classification of this quantified data achieves near-perfect sensitivity and specificity with a 98.3% accuracy rate on a convolutional neural network model.
Originality/value
To the best of the authors’ knowledge, this is the first study to incorporate VR and AI into an objective DSM-5-based ADHD diagnostic test. By including stimulation to the visual, auditory and equilibrium senses and tracking movement and recording voice, we present a method to further the research of objective ADHD diagnosis.
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22
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Morgan TC, O'Keefe LC. Does a Behavioral Parent Training Program for Parents of ADHD Children Improve Outcomes? A Pilot Project. Compr Child Adolesc Nurs 2021; 45:1-11. [PMID: 34130566 DOI: 10.1080/24694193.2021.1933263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is the most common chronic neurobehavioral disorder of childhood. Research suggests increased parent-child conflict exists in families with an ADHD child. The evidence indicates links between child behavior problems and parenting practices. Behavioral Parent Training (BPT) is an evidence-based intervention recommended for the treatment of ADHD. BPT is recommended as first-line treatment in ADHD children under age six and as a combination treatment approach for children older than the age six. BPT programs have demonstrated significant improvement in frequency of the problem behaviors of inattention, hyperactivity, and impulsivity associated with ADHD. Pre- and Post-BPT Parenting Scales and Vanderbilt ADHD Diagnostic Rating Scales for Parents and Teachers were used to evaluate the efficacy of the BPT program. Percent changes for each participant pre- and post-BPT were calculated. The Parenting Scale overall score and overreactivity factor score showed significant improvement post-BPT (p = .05). Participation in a BPT program can affect parenting practices and improve outcomes for ADHD children. BPT programs are effective in reducing negative parenting practices and improving outcomes for this population.
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Affiliation(s)
- Tracie Clark Morgan
- The College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama, USA
| | - Louise C O'Keefe
- The College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama, USA
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23
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Knowledge and Feelings of Competence with Regard to ADHD Among Support Staff in All-Day Primary Schools. SUSTAINABILITY 2021. [DOI: 10.3390/su13073696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: Schools report a high number of schoolchildren with poor attention and hyperactive behavior, with 5% being diagnosed with attention deficit/hyperactivity disorder (ADHD). This causes specific problems during homework and classroom times, and the extension of all-day schooling in German primary schools makes this a challenge for support staff working in the after-school programs. Such staff have a very wide variety of qualifications, ranging from no formal teacher training to full teaching qualifications. (2) Methods: This study documents the knowledge of 196 support staff working in all-day primary schools about ADHD, and their subjective view of whether they feel competent with regard to homework situations in general and ADHD in particular. (3) Results: Those with an educational background have significantly more knowledge than those without such a background, staff feel less prepared to supervise children with ADHD, and there is a small but significant correlation here with knowledge about ADHD. (4) Conclusions: The importance of trained pedagogical staff in the supervision of children with concentration problems is emphasized.
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24
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Shapero BG, Gibb BE, Archibald A, Wilens TE, Fava M, Hirshfeld-Becker DR. Risk Factors for Depression in Adolescents With ADHD: The Impact of Cognitive Biases and Stress. J Atten Disord 2021; 25:340-354. [PMID: 30198368 DOI: 10.1177/1087054718797447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Youth diagnosed with ADHD are at heightened risk of depression. However, many do not develop depression. Individuals with specific cognitive biases are more likely to develop depression yet it remains untested whether these vulnerability-stress models apply to depression risk in youth with ADHD. Method: We examined whether interpretation and attention biases moderated the relation between stressful life events and depressive symptoms in a sample of adolescents (Mage = 14.42) with ADHD (n = 59) and without ADHD (n = 36). Results: Youth with ADHD experienced more stressful life events compared with those without ADHD. Interpretation biases moderated the association between stress and depressive symptoms in youth with and without ADHD. Attention biases moderated the association between stress and depressive symptoms in the non-ADHD youth only. Conclusion: These results enhance our understanding of vulnerability for depression in adolescence with ADHD and inform targeted prevention and treatment models during this critical developmental juncture.
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Affiliation(s)
- Benjamin G Shapero
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Timothy E Wilens
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | - Maurizio Fava
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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25
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Wang T, Wang F, Li Y, Shi X, Duan H, Zhou K, Hua Y. Clinical Characteristics of Personality and Conduct Disorders in Child Patients With Vasovagal Syncope: A Clinical Case-Control Study. Front Pediatr 2021; 9:778605. [PMID: 34900878 PMCID: PMC8662341 DOI: 10.3389/fped.2021.778605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze the clinical characteristics of abnormal personality and conduct disorders (CDs) in pediatric patients with vasovagal syncope (VVS). Methods: In this study, we recruited patients diagnosed with VVS at Children's Heart Center from January 2018 to December 2020. Healthy children were recruited as controls. The Eysenck Personality Questionnaire-Child edition (EPQ-C) and Achenbach Child Behavior Checklist (CBCL) were used for the assessment. Results: One hundred and fifty-one VVS patients and 151 healthy controls were included in this study. Compared with the control group, patients in the VVS group had a higher incidence of abnormal personality and were more prone to suffer from CDs. Moreover, pediatric patients with VVS suffered more events of syncope recurrence if they had CDs. Conclusion: Abnormal personality and CDs are common clinical characteristics in pediatric patients with VVS.
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Affiliation(s)
- Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
| | - Fang Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
| | - Yifei Li
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
| | - Xiaoqing Shi
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
| | - Hongyu Duan
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, China
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26
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Computer-based inhibitory control training in children with Attention-Deficit/Hyperactivity Disorder (ADHD): Evidence for behavioral and neural impact. PLoS One 2020; 15:e0241352. [PMID: 33253237 PMCID: PMC7703966 DOI: 10.1371/journal.pone.0241352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychological disorder of childhood. Medication and cognitive behavioral therapy are effective treatments for many children; however, adherence to medication and therapy regimens is low. Thus, identifying effective adjunct treatments is imperative. Previous studies exploring computerized training programs as supplementary treatments have targeted working memory or attention. However, many lines of research suggest inhibitory control (IC) plays a central role in ADHD pathophysiology, which makes IC a potential intervention target. In this randomized control trial (NCT03363568), we target IC using a modified stop-signal task (SST) training designed by NeuroScouting, LLC in 40 children with ADHD, aged 8 to 11 years. Children were randomly assigned to adaptive treatment (n = 20) or non-adaptive control (n = 20) with identical stimuli and task goals. Children trained at home for at least 5 days a week (about 15m/day) for 4-weeks. Relative to the control group, the treatment group showed decreased relative theta power in resting EEG and trending improvements in parent ratings of attention (i.e. decreases in inattentive behaviors). Both groups showed improved SST performance. There was not evidence for treatment effects on hyperactivity or teacher ratings of symptoms. Results suggest training IC alone has potential to positively impact symptoms of ADHD and provide evidence for neural underpinnings of this impact (change in theta power; change in N200 latency). This shows promising initial results for the use of computerized training of IC in children with ADHD as a potential adjunct treatment option for children with ADHD.
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27
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Iznardo M, Rogers MA, Volpe RJ, Labelle PR, Robaey P. The Effectiveness of Daily Behavior Report Cards for Children With ADHD: A Meta-Analysis. J Atten Disord 2020; 24:1623-1636. [PMID: 29135352 DOI: 10.1177/1087054717734646] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This meta-analysis examined group-design studies investigating the effectiveness of Daily Behavior Report Cards (DBRC) as a school-based intervention to manage the classroom behavior of students with ADHD. Methods: A search of three article databases (PsycINFO, ERIC and Medline) identified seven group design evaluations of DBRC interventions. This meta-analysis included a total of 272 participants, with an average age of 7.9 years old. Three of the studies compared a control group to a treatment group with randomized group assignment, one study compared a control group to three treatment groups, two studies compared pre-and post-treatment scores in the same group, and one study compared pre-and post-treatment results of two intervention groups without random assignment. Dependent measures for these studies were teacher ratings (n = 5) and systematic direct observation of student academic and social behaviour (n = 2). Standardized mean differences (Hedge's g) were calculated to obtain a pooled effect size using fixed effects. Results: DBRCs were associated with reductions teacher-rated ADHD symptoms, with a Hedge's g of 0.36 (95% CI: 0.12-0.60, z=2.93, p ≤ .005) with low heterogeneity (Q-value: 2.40, I2 = 0.00). This result excluded two studies that used observational coding instead of standardized tests to evaluate the effects of the intervention. A moderator analysis indicated that the effect size for systematic direct observation was large (Hedge's G = 1.05[95% CI: 0.66-1.44, z=5.25, p ≤ .00]), with very high heterogeneity (Q-value: 46.34, I2: 93.53). A second moderator analysis found differences in the effects of DBRCs for comorbid externalizing symptoms with an overall effect size of 0.34 (95%CI: -0.04-0.72, z=1.76 p =0.08) with high heterogeneity (Q-value: 3.98, I2: 74.85). Conclusions: DBRCs effectively reduce the frequency and severity of ADHD symptoms in classroom settings. Additionally, they have a significant effect on co-occuring externalizing behaviors. It appears that systematic direct observation may be a more sensitive measure of treatment effects compared to teacher ratings of ADHD symptoms.
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Rigoni M, Blevins LZ, Rettew DC, Kasehagen L. Symptom Level Associations Between Attention-Deficit Hyperactivity Disorder and School Performance. Clin Pediatr (Phila) 2020; 59:874-884. [PMID: 32441129 DOI: 10.1177/0009922820924692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is associated with reduced school performance. To determine which ADHD symptoms and subtypes have the strongest association, we used type and frequency of symptoms on the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA) to create symptom scores for inattention and hyperactivity-impulsivity and define subtypes (ADHD-Inattentive [ADHD-I], ADHD-Hyperactive-Impulsive, ADHD-Combined [ADHD-C]). Regression methods were used to examine associations between symptoms and subtype and a composite measure of school performance. Children with ADHD-C and ADHD-I had higher adjusted odds of having reduced overall school performance (ADHD-C = 5.8, 95% confidence interval [CI] = 3.1-10.9; ADHD-I = 5.5, 95% CI = 3.1-10.1) compared with children without ADHD. All inattentive symptoms were significantly related to reduced school performance in reading, writing, and handwriting, while 6 of 9 symptoms were significantly associated in mathematics. Children with ADHD-I were significantly more likely than children with other ADHD subtypes to receive a school-based Individualized Education Program or 504 Plan. ADHD-I symptoms may be broadly linked to reduced school performance.
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Affiliation(s)
- Megan Rigoni
- Vermont Department of Health, Burlington, VT, USA
| | | | - David C Rettew
- University of Vermont, Larner College of Medicine, Burlington, VT, USA.,Vermont Department of Mental Health, Waterbury, VT, USA
| | - Laurin Kasehagen
- Vermont Department of Health, Burlington, VT, USA.,University of Vermont, Larner College of Medicine, Burlington, VT, USA.,Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Field Support Branch, MCH Epidemiology Program Team, Atlanta, GA, USA
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29
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Gin K, Stewart C, Jolley S. A systematic literature review of childhood externalizing psychopathology and later psychotic symptoms. Clin Psychol Psychother 2020; 28:56-78. [DOI: 10.1002/cpp.2493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Kimberley Gin
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
| | - Catherine Stewart
- South London and Maudsley NHS Foundation Trust United Kingdom of Great Britain and Northern Ireland London UK
| | - Suzanne Jolley
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
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30
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Kolko DJ, Hart JA, Campo J, Sakolsky D, Rounds J, Wolraich ML, Wisniewski SR. Effects of Collaborative Care for Comorbid Attention Deficit Hyperactivity Disorder Among Children With Behavior Problems in Pediatric Primary Care. Clin Pediatr (Phila) 2020; 59:787-800. [PMID: 32503395 PMCID: PMC7444430 DOI: 10.1177/0009922820920013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study evaluates the impact of a 6-month care management intervention for 206 children diagnosed with comorbid attention deficit hyperactivity disorder (ADHD) from a sample of 321 five- to 12-year-old children recruited for treatment of behavior problems in 8 pediatric primary care offices. Practices were cluster-randomized to Doctor Office Collaboration Care (DOCC) or Enhanced Usual Care (EUC). Chart reviews documented higher rates of service delivery, prescription of medication for ADHD, and titration in DOCC (vs EUC). Based on complex conditional models, DOCC showed greater acute improvement in individualized ADHD treatment goals and follow-up improvements in quality of life and ADHD and oppositional defiant disorder goals. Medication use had a significant effect on acute and follow-up ADHD symptom reduction and quality of life. Medication continuity was associated with some long-term gains. A collaborative care intervention for behavior problems that incorporated treatment guidelines for ADHD in primary care was more effective than psychoeducation and facilitated referral to community treatment.
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Affiliation(s)
- David J. Kolko
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - John Campo
- Ohio State University, Morgantown, WV, USA
| | - Dara Sakolsky
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Mark L. Wolraich
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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31
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Cuffe SP, Visser SN, Holbrook JR, Danielson ML, Geryk LL, Wolraich ML, McKeown RE. ADHD and Psychiatric Comorbidity: Functional Outcomes in a School-Based Sample of Children. J Atten Disord 2020; 24:1345-1354. [PMID: 26610741 PMCID: PMC4879105 DOI: 10.1177/1087054715613437] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Investigate the prevalence and impact of psychiatric comorbidities in community-based samples of schoolchildren with/without ADHD. Method: Teachers and parents screened children in South Carolina (SC; n = 4,604) and Oklahoma (OK; n = 12,626) for ADHD. Parents of high-screen and selected low-screen children received diagnostic interviews (SC: n = 479; OK: n = 577). Results: Psychiatric disorders were increased among children with ADHD and were associated with low academic performance. Conduct disorder/oppositional defiant disorder (CD/ODD) were associated with grade retention (ODD/CD + ADHD: odds ratio [OR] = 3.0; confidence interval [CI] = [1.5, 5.9]; ODD/CD without ADHD: OR = 4.0; CI = [1.7, 9.7]). School discipline/police involvement was associated with ADHD alone (OR = 3.2; CI = [1.5, 6.8]), ADHD + CD/ODD (OR = 14.1, CI = [7.3, 27.1]), ADHD + anxiety/depression (OR = 4.8, CI = [1.6, 14.8]), and CD/ODD alone (OR = 2.8, CI = [1.2, 6.4]). Children with ADHD + anxiety/depression had tenfold risk for poor academic performance (OR = 10.8; CI = [2.4, 49.1]) compared to children with ADHD alone. This should be interpreted with caution due to the wide confidence interval. Conclusion: Most children with ADHD have psychiatric comorbidities, which worsens functional outcomes. The pattern of outcomes varies by type of comorbidity.
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Affiliation(s)
- Steven P. Cuffe
- University of Florida College of Medicine, Jacksonville, Department of Psychiatry
| | - Susanna N. Visser
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability, in Atlanta, GA
| | - Joseph R. Holbrook
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability, in Atlanta, GA
| | - Melissa L. Danielson
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability, in Atlanta, GA
| | - Lorie L. Geryk
- University of North Carolina – Chapel Hill, Eshelman School of Pharmacy
| | - Mark L. Wolraich
- University of Oklahoma Health Sciences Center, Child Study Center
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32
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Holdaway AS, Hustus CL, Owens JS, Evans SW, Coles EK, Egan TE, Himawan L, Zoromski AK, Dawson AE, Mixon CS. Incremental Benefits of a Daily Report Card Over Time for Youth with Disruptive Behavior: Replication and Extension. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09375-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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33
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Shang CY, Shih HH, Pan YL, Lin HY, Gau SSF. Comparative Efficacy of Methylphenidate and Atomoxetine on Social Adjustment in Youths with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:148-158. [PMID: 31794244 DOI: 10.1089/cap.2019.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Although methylphenidate and atomoxetine have positive effects in reducing core symptoms and emotional/behavioral problems of attention-deficit/hyperactivity disorder (ADHD), little is known about their efficacy in improving social adjustment problems among youths with ADHD. Methods: A total of 168 drug-naive youths, 7-16 years of age, with DSM-IV-defined ADHD, were recruited and randomly assigned to osmotic-release oral system methylphenidate (n = 83) and atomoxetine (n = 85) in a 24-week, open-label, head-to-head clinical trial. Efficacy measurement was based on the parent-rated and self-rated Social Adjustment Inventory for Children and Adolescents (SAICA). Evaluation time points were set at baseline and weeks 8, 16, and 24. Results: At week 24, methylphenidate was associated with improvement in school functions (parent report: Cohen d = -0.82; self-report: Cohen d = -0.66) and peer relationships (parent report: Cohen d = -0.50; self-report: Cohen d = -0.25); and atomoxetine was associated with improvement in school functions (parent report: Cohen d = -0.62; self-report: Cohen d = -0.34) and peer relationships (parent report: Cohen d = -0.33; self-report: Cohen d = -0.65). In terms of parent-reported and self-reported ratings, there were no significant differences between the two treatment groups in mean reduction in the severity of school dysfunctions, impaired peer relationships, and behavioral problems at home at week 24. Conclusions: Our findings lend evidence to support that both methylphenidate and atomoxetine were comparably effective in improving social adjustment in youths with ADHD, including school functions and peer relationships.
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Affiliation(s)
- Chi-Yung Shang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Hsueh Shih
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Yun-Ling Branch, Yun-Ling, Taiwan
| | - Yi-Lei Pan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Child and Adolescent Psychiatry, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Hsiang-Yuan Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences and Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
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34
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Schmiedeler S, Khambatta K, Hartmann J, Niklas F. Wenn den Zappelphilipp die Aufschieberitis packt: Zusammenhänge zwischen ADHS-Symptomen und Prokrastination und mögliche Mediatoren. ZEITSCHRIFT FUR PADAGOGISCHE PSYCHOLOGIE 2020. [DOI: 10.1024/1010-0652/a000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Die Aufmerksamkeitsdefizit- / Hyperaktivitätsstörung (ADHS) scheint mit prokrastinierendem Verhalten in Verbindung zu stehen und beides kann den individuellen Bildungserfolg beeinträchtigen. Weitere Studien weisen zudem auf Zusammenhänge zwischen den beiden Konstrukten und Selbstkontrolle sowie Perfektionismus hin. In der vorliegenden Arbeit wurde anhand von zwei verschiedenen Stichproben ( N gesamt = 762) untersucht, ob Zusammenhänge zwischen ADHS-Symptomen und Prokrastination bestehen und ob diese Zusammenhänge durch Selbstkontrolle und Perfektionismus mediiert werden. Die Ergebnisse zeigen positive Assoziationen zwischen Prokrastination und den ADHS-Subskalen für beide Stichproben (Unaufmerksamkeit: r = .67 bzw. r = .66; Hyperaktivität / Impulsivität: r = .35 bzw. r = 0.22). Dabei wurden indirekte Effekte von der ADHS-Gesamtskala sowie den beiden Subskalen Unaufmerksamkeit und Hyperaktivität / Impulsivität auf Prokrastination über Selbstkontrolle deutlich. Zudem zeigte sich ein indirekter Effekt von Hyperaktivität / Impulsivität auf Prokrastination über sozial vorgeschriebenen Perfektionismus. Ein Teil des Zusammenhangs zwischen ADHS-Symptomen und Prokrastination kann demnach durch indirekte Effekte über dritte Konstrukte erklärt werden.
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Affiliation(s)
| | - Kay Khambatta
- Lehrstuhl für Psychologie IV der Universität Würzburg, Würzburg
| | - Julia Hartmann
- Lehrstuhl für Psychologie IV der Universität Würzburg, Würzburg
| | - Frank Niklas
- Lehrstuhl für Psychologie IV der Universität Würzburg, Würzburg
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35
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Caci H, Cohen D, Bonnot O, Kabuth B, Raynaud JP, Paillé S, Vallée L. Health Care Trajectories for Children With ADHD in France: Results From the QUEST Survey. J Atten Disord 2020; 24:52-65. [PMID: 26794670 DOI: 10.1177/1087054715618790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study is to retrospectively describe the pathway toward ADHD diagnosis and treatment, and identify potential areas for improvement. Method: Parent-reported questionnaires were collected by a national sample of ADHD specialists. Results: In total, 473 complete questionnaires were analyzed. Initial onset of ADHD symptoms was reported at a mean age of 4.45 years. Mean age at diagnosis was 8.07 years, and half of the families had seen at least three health care professionals previously. Psychiatrists were most commonly consulted. A "combined" (89% boys) and inattentive (49% boys) profile was identified. Diagnosis was made 1 year later for the latter group. Two thirds of patients received pharmacological treatment. The delay in diagnosis was identified as the main source of concern for caregivers. Conclusion: The 4-year delay in diagnosis may represent a loss of opportunity. Training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.
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Affiliation(s)
- Hervé Caci
- Hôpitaux Pédiatriques de Nice CHU Lenval, France
| | - David Cohen
- Pitié-Salpétrière Hospital Group, Paris, France
| | | | | | - Jean-Phillipe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (SUPEA), Toulouse University Hospital, France
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36
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Abstract
Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations also affect biological psychiatry and are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. Moreover, journalists are unaware that initial studies, even when positive and promising, are inherently uncertain. Journalists preferentially cover them and almost never inform the public when those studies are disconfirmed by subsequent research. This explains why reductionist theories about mental health often persist in mass media even though the scientific claims that have been put forward to support them have long been contradicted. These misrepresentations affect the care of patients. Indeed, studies show that a neuro-essentialist conceptualization of mental disorders negatively affects several aspects of stigmatization, reduces the chances of patients' healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering. Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.
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37
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Bergwerff CE, Luman M, Weeda WD, Oosterlaan J. Neurocognitive Profiles in Children With ADHD and Their Predictive Value for Functional Outcomes. J Atten Disord 2019; 23:1567-1577. [PMID: 28135892 DOI: 10.1177/1087054716688533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examined whether neurocognitive profiles could be distinguished in children with ADHD and typically developing (TD) children, and whether neurocognitive profiles predicted externalizing, social, and academic problems in children with ADHD. METHOD Neurocognitive data of 81 children with ADHD and 71 TD children were subjected to confirmatory factor analysis. The resulting factors were used for community detection in the ADHD and TD group. RESULTS Four subgroups were detected in the ADHD group, characterized by (a) poor emotion recognition, (b) poor interference control, (c) slow processing speed, or (d) increased attentional lapses and fast processing speed. In the TD group, three subgroups were detected, closely resembling Subgroups (a) to (c). Neurocognitive subgroups in the ADHD sample did not differ in externalizing, social, and academic problems. CONCLUSION We found a neurocognitive profile unique to ADHD. The clinical validity of neurocognitive profiling is questioned, given the lack of associations with functional outcomes.
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Affiliation(s)
| | | | - Wouter D Weeda
- 1 Vrije Universiteit Amsterdam, The Netherlands.,2 Leiden University, The Netherlands
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38
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Hiscock H, Mulraney M, Heussler H, Rinehart N, Schuster T, Grobler AC, Gold L, Bohingamu Mudiyanselage S, Hayes N, Sciberras E. Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial. J Child Psychol Psychiatry 2019; 60:1230-1241. [PMID: 31184382 DOI: 10.1111/jcpp.13083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost-effective when delivered by pediatricians or psychologists in community settings. METHODS Translational, cluster-randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5-13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep-wake phase disorder, or were experiencing sleep-related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. RESULTS In an intention-to-treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost-effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. CONCLUSIONS A low-cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.
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Affiliation(s)
- Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia.,Health Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Mulraney
- Health Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Helen Heussler
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Nicole Rinehart
- Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit and Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Anneke C Grobler
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit and Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | - Nicole Hayes
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Emma Sciberras
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia
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Perrin HT, Heller NA, Loe IM. School Readiness in Preschoolers With Symptoms of Attention-Deficit/Hyperactivity Disorder. Pediatrics 2019; 144:e20190038. [PMID: 31331986 PMCID: PMC6855898 DOI: 10.1542/peds.2019-0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare school readiness in preschoolers with and without attention-deficit/hyperactivity disorder (ADHD) symptoms using a comprehensive framework. We hypothesized that preschoolers with ADHD symptoms have higher odds of school readiness impairment. METHODS Children ages 4 to 5 years (n = 93) were divided into 2 groups on the basis of presence of ADHD symptoms (ADHD group, n = 45; comparison group, n = 48). School readiness was assessed through 10 component measures, including direct assessments and standardized questionnaires, regarding 5 school readiness domains: physical well-being and motor development, social and emotional development, approaches to learning, language, and cognition and general knowledge. Analysis of covariance compared group mean scores on component measures. Domain impairment was defined as score ≥1 SD from the test population mean in the unfavorable direction on ≥1 measure in the domain. School readiness impairment was defined as impairment in ≥2 of 5 domains. Logistic regression predicted impairment within domains and overall readiness. RESULTS The ADHD group demonstrated significantly worse mean scores on 8 of 10 component measures and greater odds of impairment in all domains except for cognition and general knowledge. Overall, 79% of the ADHD group and 13% of the comparison group had school readiness impairment (odds ratio 21, 95% confidence interval 5.67-77.77, P < .001). CONCLUSIONS Preschoolers with ADHD symptoms are likely to have impaired school readiness. We recommend early identification of school readiness impairment by using a comprehensive 5-domain framework in children with ADHD symptoms paired with targeted intervention to improve outcomes.
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Affiliation(s)
- Hannah T Perrin
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Nicole A Heller
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Irene M Loe
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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40
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Muñoz-Suazo MD, Navarro-Muñoz J, Díaz-Román A, Porcel-Gálvez AM, Gil-García E. Sex differences in neuropsychological functioning among children with attention-deficit/hyperactivity disorder. Psychiatry Res 2019; 278:289-293. [PMID: 31254878 DOI: 10.1016/j.psychres.2019.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022]
Abstract
Cognitive impairments are often reported in research on children with attention-deficit/hyperactivity disorder (ADHD). However, studies analyzing sex differences in this context are still sparse. This study aimed to compare the neuropsychological performance of boys and girls with ADHD across several cognitive domains. Verbal comprehension, perceptual reasoning, working memory, processing speed, and general cognitive performance were assessed in 240 children aged 6-17 years: 120 children (65 boys) with a clinical diagnosis of ADHD and 120 typically developing children (60 boys). Underperformance of children with ADHD compared to controls was observed in all the evaluated cognitive domains, except for verbal comprehension. Significantly lower scores in perceptual reasoning, with a medium effect size, were found in girls with ADHD relative to boys, although the sexes did not significantly differ in terms of the remaining variables. Children's ADHD subtypes did not correlate significantly with any performance measure, and no significant interaction effects between children's age and sex were noted in the results. The performance commonalities found between boys and girls with ADHD outweighed the differences, which highlights the importance of further research on cognitive dysfunction in girls with ADHD, regardless of sex differences in the prevalence of the disorder.
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Affiliation(s)
| | | | - Amparo Díaz-Román
- Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Granada, Spain.
| | - Ana María Porcel-Gálvez
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain
| | - Eugenia Gil-García
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain
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41
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Ornoy A, Spivak A. Cost effectiveness of optimal treatment of ADHD in Israel: a suggestion for national policy. HEALTH ECONOMICS REVIEW 2019; 9:24. [PMID: 31289954 PMCID: PMC6734254 DOI: 10.1186/s13561-019-0240-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/26/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVES There are well known behavioral complications of ADHD at adulthood such as learning difficulties resulting in lower education attainments; increased rate of car and other accidents; substance abuse; misconduct and imprisonment. These complications can be prevented or alleviated by effective treatment. In this study we calculated the economic burden of ADHD among adults in Israel and the cost of diagnosing and treating ADHD from childhood to adulthood. We then obtained the cost-benefit ratio of the treatment. METHODS The data were calculated using accepted estimations of prevalence and cost for the Israeli population assuming a prevalence of 4% among adults which is based on the ADHD prevalence among school age children. RESULTS The estimated cost per person with ADHD due to lower education attainment, higher involvement in crime and car accidents and more drug abuse is 289,969 USD and the estimated cost for optimal treatment is 41,667 USD. Hence, the benefit cost ratio is 7.02 and, assuming only 50% success of treatment, it is 3.51, still a very high cost benefit ratio. CONCLUSIONS Since early diagnosis and appropriate treatment of ADHD is very effective in reducing the various symptoms and complications at adulthood thus enabling a better education and higher income, it seems important to diagnose and offer comprehensive treatment to children with ADHD. Moreover, it seems equally important to continue treatment at adulthood.
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Affiliation(s)
- Asher Ornoy
- Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Avia Spivak
- Department of Economics, Ben Gurion University, Beersheba, Israel
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Nguyen MN, Watanabe-Galloway S, Hill JL, Siahpush M, Tibbits MK, Wichman C. Ecological model of school engagement and attention-deficit/hyperactivity disorder in school-aged children. Eur Child Adolesc Psychiatry 2019; 28:795-805. [PMID: 30390147 DOI: 10.1007/s00787-018-1248-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
School engagement protects against negative mental health outcomes; however, few studies examined the relationship between school engagement and attention-deficit hyperactivity disorder (ADHD) using an ecological framework. The aims were to examine: (1) whether school engagement has an independent protective association against the risk of ADHD in children, and (2) whether environmental factors have an association with ADHD either directly or indirectly via their association with school engagement. This cross-sectional study used data from the 2011-2012 National Survey of Children's Health, which collected information about children's mental health, family life, school, and community. The sample contained 65,680 children aged 6-17 years. Structural equation modeling was used to estimate the direct association of school engagement and ADHD and indirect associations of latent environmental variables (e.g., family socioeconomic status (SES), adverse childhood experiences (ACEs), environmental safety, and neighborhood amenities) and ADHD. School engagement had a direct and inverse relationship with ADHD (β = - 0.35, p < 0.001) such that an increase in school engagement corresponds with a decrease in ADHD diagnosis. In addition, family SES (β = - 0.03, p = 0.002), ACEs (β = 0.10, p < 0.001), environment safety (β = - 0.10, p < 0.001), and neighborhood amenities (β = - 0.01, p = 0.025) all had an indirect association with ADHD via school engagement. In conclusion, school engagement had a direct association with ADHD. Furthermore, environmental correlates showed indirect associations with ADHD via school engagement. School programs targeted at reducing ADHD should consider family and community factors in their interventions.
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Affiliation(s)
- Minh N Nguyen
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Jennie L Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Melissa K Tibbits
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Christopher Wichman
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
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43
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Gesser-Edelsburg A, Hamade Boukai R. Does the education system serve as a persuasion agent for recommending ADHD diagnosis and medication uptake? A qualitative case study to identify and characterize the persuasion strategies of Israeli teachers and school counselors. BMC Psychiatry 2019; 19:153. [PMID: 31101094 PMCID: PMC6525420 DOI: 10.1186/s12888-019-2120-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a steady rise in the use of medication by Israeli school children to treat ADHD, partly due to what seems like school teachers' and counselors' tendency to express positive attitudes towards its use. Therfore it is important to examine the involvement of the school teachers and counselors in the parents' decision-making about giving their children medication. METHODS This study used a qualitative constructivist research method of semi-structured interviews. It included individual interviews with 36 teachers and school counselors and 11 parents of students ages 9-14 from the Jewish and Arab populations. RESULTS Teachers and school counselors use different strategies to encourage parents to have their children diagnosed for ADHD and medicated. First they suggest diagnosis as a necessary step in the best interest of the child, distinguishing between diagnosis and medication to mitigate parents' concerns. In the second stage, teachers normalize the use of medication, as well as framing it as a drug that provides not only a medical treatment but also emotional wellbeing. CONCLUSIONS Teachers and counselors are involved in parents' decision-making process about medicating their children to treat ADHD, which contradicts the education system's guidelines. It is necessary to set clear and explicit limits and guidelines for education system employees so that they do not cross professional and ethical limits.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel. .,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel.
| | - Rasha Hamade Boukai
- 0000 0004 1937 0562grid.18098.38School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838 Haifa, Israel
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Longridge R, Norman S, Henley W, Newlove Delgado T, Ford T. Investigating the agreement between the clinician and research diagnosis of attention deficit hyperactivity disorder and how it changes over time; a clinical cohort study. Child Adolesc Ment Health 2019; 24:133-141. [PMID: 32677186 DOI: 10.1111/camh.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a common reason for referral to Child and Adolescent Mental Health Services (CAMHS), but families experience long delays between first professional contact and diagnosis, which risks development of secondary impairments. This study explores the agreement between clinician and research diagnoses of ADHD among children attending CAMHS, and their access to interventions. From the limited literature, we anticipated fluctuation and delays, but no other study has focused prospectively on ADHD diagnoses. METHODS This was a secondary analysis of a cohort of children attending two CAMHS between 2006 and 2009. The sample included 288 consecutive referrals of children aged between 5 and 11 years. Parents and teachers completed the Development and Well-Being Assessment (DAWBA) when the child was recruited to the study, which provided the research diagnosis of ADHD from the baseline. Clinicians reported no, possible, or definite diagnosis of ADHD and interventions provided at 6-monthly intervals for up to 2 years while the child attended CAMHS. We assessed agreement between the diagnoses using Kendall's Tau-B. RESULTS Of the 101 children with a research diagnosis of ADHD, 26 received a definite clinician diagnosis during 2-year follow-up, and 47 received a possible clinician diagnosis. The chance-corrected agreement was poor at all time points (Kendall's Tau-B 0.14-0.48). Clinician diagnoses were unstable, particularly if possible ADHD was recorded at the initial assessment. Of those with a research diagnosis, 15 were prescribed medication and 11 were offered parent training. CONCLUSIONS The use of standardised diagnostic assessments could reduce diagnostic uncertainty and increase access to evidence-based interventions.
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Affiliation(s)
| | - Shelley Norman
- Child Health Research Group, University of Exeter, Exeter, UK
| | | | | | - Tamsin Ford
- Child Health Research Group, University of Exeter, Exeter, UK
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45
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Effatpanah M, Rezaei M, Effatpanah H, Effatpanah Z, Varkaneh HK, Mousavi SM, Fatahi S, Rinaldi G, Hashemi R. Magnesium status and attention deficit hyperactivity disorder (ADHD): A meta-analysis. Psychiatry Res 2019; 274:228-234. [PMID: 30807974 DOI: 10.1016/j.psychres.2019.02.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 12/18/2022]
Abstract
Current research suggests conflicting evidence surrounding the association between serum magnesium levels and the diagnosis of attention deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aims to explore, summarize and quantify the published literature addressing this topic. We conducted an exhaustive literature search on Scopus and PubMed for all the relevant observational studies published up to August 2018. A meta-analysis using a random-effects model was used to summarize the overall association between serum magnesium level and ADHD from the available data. We identified seven studies which reported the mean and standard deviation (SD) of magnesium concentration in both ADHD and control groups. The random-effects meta-analysis showed that subjects with ADHD had 0.105 mmol/l (95% CI: -0.188, -0.022; P < 0.013) lower serum magnesium levels compared with to their healthy controls. Moreover, we observed striking and statistically significant heterogeneity among the included studies (I2 = 96.2%, P = 0.0103). The evidence from this meta-analysis supports the theory that an inverse relationship between serum magnesium deficiency and ADHD exists. High heterogeneity amongst the included studies suggests that there is a residual need for observational and community-based studies to further investigate this issue.
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Affiliation(s)
- Mohammad Effatpanah
- Department of Psychiatry, Ziaeian Hospital, School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mahdi Rezaei
- Department of Psychiatry, Ziaeian Hospital, School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Hosein Effatpanah
- Department of Microbiology, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Zeynab Effatpanah
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Kord Varkaneh
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammad Mousavi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Somaye Fatahi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Rezvan Hashemi
- Department of Geriatric Medicine, Ziaeian Hospital, School of Medicine, Tehran University of Medical Science, Tehran, Iran.
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46
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Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD. ACTA ACUST UNITED AC 2019; 11:289-298. [PMID: 30852727 DOI: 10.1007/s12402-019-00293-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
This study examines how ADHD-related symptoms and impairments interact to predict depression symptoms in young adolescents with ADHD. A sample of 342 adolescents (71% male, mean age = 13 years old) with DSM-IV-TR diagnosed ADHD completed baseline clinical assessments upon entry to a psychosocial treatment study for ADHD. Ratings of ADHD and sluggish cognitive tempo (SCT) symptoms, and social and academic impairment were obtained from parents, while ratings of depressive symptoms and conflict with parents were obtained from youth. Among adolescents with ADHD, elevated depressive symptoms were associated with higher SCT symptom severity, lower hyperactive/impulsive (HI) symptom severity, higher social impairments, higher conflict with parents, and lower academic problems. Interaction effects indicated that clinically significant depressive symptoms were most likely to occur when high levels of parent-youth conflict were present along with high inattentive (IN) symptoms, high SCT, and/or low HI. Among children and adolescents with ADHD, depression prevention efforts might target IN/SCT symptom management, as well as improving interpersonal relationships with parents and peers. Future work is needed to verify these findings longitudinally.
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Demontis D, Walters RK, Martin J, Mattheisen M, Als TD, Agerbo E, Baldursson G, Belliveau R, Bybjerg-Grauholm J, Bækvad-Hansen M, Cerrato F, Chambert K, Churchhouse C, Dumont A, Eriksson N, Gandal M, Goldstein JI, Grasby KL, Grove J, Gudmundsson OO, Hansen CS, Hauberg ME, Hollegaard MV, Howrigan DP, Huang H, Maller JB, Martin AR, Martin NG, Moran J, Pallesen J, Palmer DS, Pedersen CB, Pedersen MG, Poterba T, Poulsen JB, Ripke S, Robinson EB, Satterstrom FK, Stefansson H, Stevens C, Turley P, Walters GB, Won H, Wright MJ, Andreassen OA, Asherson P, Burton CL, Boomsma DI, Cormand B, Dalsgaard S, Franke B, Gelernter J, Geschwind D, Hakonarson H, Haavik J, Kranzler HR, Kuntsi J, Langley K, Lesch KP, Middeldorp C, Reif A, Rohde LA, Roussos P, Schachar R, Sklar P, Sonuga-Barke EJS, Sullivan PF, Thapar A, Tung JY, Waldman ID, Medland SE, Stefansson K, Nordentoft M, Hougaard DM, Werge T, Mors O, Mortensen PB, Daly MJ, Faraone SV, Børglum AD, Neale BM. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 2019; 51:63-75. [PMID: 30478444 DOI: 10.1101/145581] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/28/2018] [Indexed: 05/27/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a highly heritable childhood behavioral disorder affecting 5% of children and 2.5% of adults. Common genetic variants contribute substantially to ADHD susceptibility, but no variants have been robustly associated with ADHD. We report a genome-wide association meta-analysis of 20,183 individuals diagnosed with ADHD and 35,191 controls that identifies variants surpassing genome-wide significance in 12 independent loci, finding important new information about the underlying biology of ADHD. Associations are enriched in evolutionarily constrained genomic regions and loss-of-function intolerant genes and around brain-expressed regulatory marks. Analyses of three replication studies: a cohort of individuals diagnosed with ADHD, a self-reported ADHD sample and a meta-analysis of quantitative measures of ADHD symptoms in the population, support these findings while highlighting study-specific differences on genetic overlap with educational attainment. Strong concordance with GWAS of quantitative population measures of ADHD symptoms supports that clinical diagnosis of ADHD is an extreme expression of continuous heritable traits.
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Affiliation(s)
- Ditte Demontis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Raymond K Walters
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Joanna Martin
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Manuel Mattheisen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas D Als
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Gísli Baldursson
- Department of Child and Adolescent Psychiatry, National University Hospital, Reykjavik, Iceland
| | - Rich Belliveau
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jonas Bybjerg-Grauholm
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Marie Bækvad-Hansen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Felecia Cerrato
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kimberly Chambert
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Claire Churchhouse
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ashley Dumont
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Michael Gandal
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment and Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline I Goldstein
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Olafur O Gudmundsson
- Department of Child and Adolescent Psychiatry, National University Hospital, Reykjavik, Iceland
- deCODE genetics/Amgen, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Christine S Hansen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Institute of Biological Psychiatry, MHC Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Mads Engel Hauberg
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Mads V Hollegaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Daniel P Howrigan
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Hailiang Huang
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julian B Maller
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Genomics plc, Oxford, UK
| | - Alicia R Martin
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jennifer Moran
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jonatan Pallesen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Duncan S Palmer
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carsten Bøcker Pedersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Marianne Giørtz Pedersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Timothy Poterba
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jesper Buchhave Poulsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Stephan Ripke
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - Elise B Robinson
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
| | - F Kyle Satterstrom
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Christine Stevens
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Patrick Turley
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - G Bragi Walters
- deCODE genetics/Amgen, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hyejung Won
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment and Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christie L Burton
- Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Dorret I Boomsma
- Department of Biological Psychology, Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Søren Dalsgaard
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Barbara Franke
- Departments of Human Genetics (855) and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joel Gelernter
- Department of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Daniel Geschwind
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment and Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hakon Hakonarson
- The Center for Applied Genomics, The Children´s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| | - Henry R Kranzler
- Department of Psychiatry, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Veterans Integrated Service Network (VISN4) Mental Illness Research, Education, and Clinical Center (MIRECC), Crescenz VA Medical Center, Philadephia, PA, USA
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Langley
- MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Center of Mental Health, University of Wuerzburg, Wuerzburg, Germany
- Department of Neuroscience, School for Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, The Netherlands
- Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Christel Middeldorp
- Department of Biological Psychology, Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
- Child Health Research Centre, University of Queensland, Brisbane, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis Augusto Rohde
- Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Panos Roussos
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Russell Schachar
- Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Pamela Sklar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kari Stefansson
- deCODE genetics/Amgen, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - David M Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Institute of Biological Psychiatry, MHC Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Mark J Daly
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Anders D Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark.
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark.
| | - Benjamin M Neale
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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Demontis D, Walters RK, Martin J, Mattheisen M, Als TD, Agerbo E, Baldursson G, Belliveau R, Bybjerg-Grauholm J, Bækvad-Hansen M, Cerrato F, Chambert K, Churchhouse C, Dumont A, Eriksson N, Gandal M, Goldstein JI, Grasby KL, Grove J, Gudmundsson OO, Hansen CS, Hauberg ME, Hollegaard MV, Howrigan DP, Huang H, Maller JB, Martin AR, Martin NG, Moran J, Pallesen J, Palmer DS, Pedersen CB, Pedersen MG, Poterba T, Poulsen JB, Ripke S, Robinson EB, Satterstrom FK, Stefansson H, Stevens C, Turley P, Walters GB, Won H, Wright MJ, Andreassen OA, Asherson P, Burton CL, Boomsma DI, Cormand B, Dalsgaard S, Franke B, Gelernter J, Geschwind D, Hakonarson H, Haavik J, Kranzler HR, Kuntsi J, Langley K, Lesch KP, Middeldorp C, Reif A, Rohde LA, Roussos P, Schachar R, Sklar P, Sonuga-Barke EJS, Sullivan PF, Thapar A, Tung JY, Waldman ID, Medland SE, Stefansson K, Nordentoft M, Hougaard DM, Werge T, Mors O, Mortensen PB, Daly MJ, Faraone SV, Børglum AD, Neale BM. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 2019; 51:63-75. [PMID: 30478444 PMCID: PMC6481311 DOI: 10.1038/s41588-018-0269-7] [Citation(s) in RCA: 1156] [Impact Index Per Article: 231.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/28/2018] [Indexed: 02/07/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a highly heritable childhood behavioral disorder affecting 5% of children and 2.5% of adults. Common genetic variants contribute substantially to ADHD susceptibility, but no variants have been robustly associated with ADHD. We report a genome-wide association meta-analysis of 20,183 individuals diagnosed with ADHD and 35,191 controls that identifies variants surpassing genome-wide significance in 12 independent loci, finding important new information about the underlying biology of ADHD. Associations are enriched in evolutionarily constrained genomic regions and loss-of-function intolerant genes and around brain-expressed regulatory marks. Analyses of three replication studies: a cohort of individuals diagnosed with ADHD, a self-reported ADHD sample and a meta-analysis of quantitative measures of ADHD symptoms in the population, support these findings while highlighting study-specific differences on genetic overlap with educational attainment. Strong concordance with GWAS of quantitative population measures of ADHD symptoms supports that clinical diagnosis of ADHD is an extreme expression of continuous heritable traits.
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Affiliation(s)
- Ditte Demontis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Raymond K Walters
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Joanna Martin
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Manuel Mattheisen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas D Als
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Gísli Baldursson
- Department of Child and Adolescent Psychiatry, National University Hospital, Reykjavik, Iceland
| | - Rich Belliveau
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jonas Bybjerg-Grauholm
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Marie Bækvad-Hansen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Felecia Cerrato
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kimberly Chambert
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Claire Churchhouse
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ashley Dumont
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Michael Gandal
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment and Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline I Goldstein
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Olafur O Gudmundsson
- Department of Child and Adolescent Psychiatry, National University Hospital, Reykjavik, Iceland
- deCODE genetics/Amgen, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Christine S Hansen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Institute of Biological Psychiatry, MHC Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Mads Engel Hauberg
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Mads V Hollegaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Daniel P Howrigan
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Hailiang Huang
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julian B Maller
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Genomics plc, Oxford, UK
| | - Alicia R Martin
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jennifer Moran
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jonatan Pallesen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Duncan S Palmer
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carsten Bøcker Pedersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Marianne Giørtz Pedersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Timothy Poterba
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jesper Buchhave Poulsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Stephan Ripke
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - Elise B Robinson
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
| | - F Kyle Satterstrom
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Christine Stevens
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Patrick Turley
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - G Bragi Walters
- deCODE genetics/Amgen, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hyejung Won
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment and Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | | | | | | | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christie L Burton
- Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Dorret I Boomsma
- Department of Biological Psychology, Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Søren Dalsgaard
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Barbara Franke
- Departments of Human Genetics (855) and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joel Gelernter
- Department of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Daniel Geschwind
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment and Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hakon Hakonarson
- The Center for Applied Genomics, The Children´s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| | - Henry R Kranzler
- Department of Psychiatry, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Veterans Integrated Service Network (VISN4) Mental Illness Research, Education, and Clinical Center (MIRECC), Crescenz VA Medical Center, Philadephia, PA, USA
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Langley
- MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Center of Mental Health, University of Wuerzburg, Wuerzburg, Germany
- Department of Neuroscience, School for Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, The Netherlands
- Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Christel Middeldorp
- Department of Biological Psychology, Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
- Child Health Research Centre, University of Queensland, Brisbane, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis Augusto Rohde
- Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Panos Roussos
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Russell Schachar
- Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Pamela Sklar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kari Stefansson
- deCODE genetics/Amgen, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - David M Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Institute of Biological Psychiatry, MHC Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Mark J Daly
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Anders D Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark.
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark.
| | - Benjamin M Neale
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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49
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Taylor HG, Orchinik L, Fristad MA, Minich N, Klein N, Espy KA, Schluchter M, Hack M. Associations of Attention Deficit Hyperactivity Disorder (ADHD) at School Entry with Early Academic Progress in Children Born Prematurely and Full-Term Controls. LEARNING AND INDIVIDUAL DIFFERENCES 2019; 69:1-10. [PMID: 31223221 PMCID: PMC6586420 DOI: 10.1016/j.lindif.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H Gerry Taylor
- Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute and Department of Pediatrics, The Ohio State University, Columbus, OH
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Leah Orchinik
- Department of Pediatrics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE and Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH
| | - Nori Minich
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Nancy Klein
- Department of Education, Cleveland State University, Cleveland, OH
| | | | - Mark Schluchter
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Maureen Hack
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
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50
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Moran A, Serban N, Danielson ML, Grosse SD, Cuffe SP. Adherence to Recommended Care Guidelines in the Treatment of Preschool-Age Medicaid-Enrolled Children With a Diagnosis of ADHD. Psychiatr Serv 2019; 70:26-34. [PMID: 30373494 PMCID: PMC6408287 DOI: 10.1176/appi.ps.201800204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. Clinical guidelines recommend behavior therapy as the first-line treatment for preschool-age children with ADHD. This study evaluated longitudinal patterns of services received by Medicaid-enrolled children ages 2 to 5 with ADHD in seven southeastern states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina). METHODS A discrete sequence clustering analysis was used with 2005-2012 Medicaid Analytic eXtract data to profile patient-level utilization for each state, with a focus on receipt of psychological services and medication. The model output was used to assess utilization behaviors longitudinally relative to recommended care guidelines and to characterize sources of variation in utilization patterns by demographic and ecological factors. RESULTS Five states had a utilization profile with a high probability of receipt of psychological services before medication among children with ADHD, covering 16% of the total study population. Most young children's ADHD care experience in the seven states (65%) fit utilization profiles characterized by a high probability of receiving any ADHD medication. Black race was significantly associated with higher utilization of psychological services in three states. CONCLUSIONS About 16% of Medicaid-enrolled preschool-age children with ADHD received care during 2005-2012 that appeared to be consistent with 2011 recommended care guidelines. State-level and subpopulation variations in utilization for ADHD-related clinical care were found. The findings indicate that there were major gaps in treatment for ADHD among young children and that the gaps are wider for some states and subpopulations of children.
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Affiliation(s)
- Alex Moran
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta (Moran, Serban); National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Danielson, Grosse); Department of Psychiatry, University of Florida College of Medicine, Jacksonville (Cuffe)
| | - Nicoleta Serban
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta (Moran, Serban); National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Danielson, Grosse); Department of Psychiatry, University of Florida College of Medicine, Jacksonville (Cuffe)
| | - Melissa L Danielson
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta (Moran, Serban); National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Danielson, Grosse); Department of Psychiatry, University of Florida College of Medicine, Jacksonville (Cuffe)
| | - Scott D Grosse
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta (Moran, Serban); National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Danielson, Grosse); Department of Psychiatry, University of Florida College of Medicine, Jacksonville (Cuffe)
| | - Steven P Cuffe
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta (Moran, Serban); National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Danielson, Grosse); Department of Psychiatry, University of Florida College of Medicine, Jacksonville (Cuffe)
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